Over the last decade the trend in surgical nursing has been towards more involvement of the patient in care and decision-making. The ideology of the nursing process can enable the family and the patient to become involved and to exercise individual rights. Within the framework of the nursing process the nurse has been encouraged to perceive and relate to patients in terms of their common and particular personal needs. Furthermore, the patient has a right to contribute to the decision-making process. From the patient's perspective this has been a welcomed change. In recent years patients' rights movements and the development of patients' charters within hospitals and health authorities have been focal. From the nurses' perspective this means that the patient has a right to challenge decisions and treatment. This in turn may lead to nurses' examining and questioning standards of care and professional accountability.